Cancer institute, Geisinger Health System, Danville, PA, USA.
Breast Cancer (Dove Med Press). 2011 Oct 20;3:127-37. doi: 10.2147/BCTT.S11288.
Risk factors allow us to define women who are at increased lifetime risk for breast cancer, and the most important factor is age. Benign breast disease increases risk, and the most important histologies are atypical lobular or ductal hyperplasia and lobular carcinoma in situ. Family history of breast cancer among first-degree relatives (mother, sisters, daughters) also increases risk. Quantitative measures of risk give accurate predictions of breast cancer incidence for groups of women but not for individual subjects. Multiple published, randomized controlled trials, which employed selective estrogen receptor (ER) modulators (SERMs), have demonstrated consistent reductions of 35% or greater in the risk of ER-positive invasive and noninvasive breast cancer in postmenopausal women. Professional organizations in the US now recommend the use of SERMs to reduce the risk of breast cancer in high-risk, postmenopausal women. Raloxifene and tamoxifen reduce the risk of ER-positive invasive breast cancer with equal efficacy, but raloxifene is associated with a lower risk of thromboembolic disease, benign uterine conditions, and cataracts than tamoxifen in postmenopausal women. No evidence exists establishing whether a reduction in breast cancer risk from either agent translates into reduced breast cancer mortality. Overall quality of life is similar with raloxifene or tamoxifen, but the incidence of dyspareunia, weight gain, and musculoskeletal complaints is higher with raloxifene use, whereas vasomotor symptoms, bladder incontinence, gynecologic symptoms, and leg cramps were higher with tamoxifen use.
风险因素使我们能够确定一生中乳腺癌风险增加的女性，最重要的因素是年龄。良性乳腺疾病会增加风险，最重要的组织学表现为非典型小叶或导管增生和小叶原位癌。一级亲属（母亲、姐妹、女儿）的乳腺癌家族史也会增加风险。定量风险评估可以准确预测女性群体的乳腺癌发病率，但不能预测个体。多项已发表的、采用选择性雌激素受体（ER）调节剂（SERM）的随机对照试验表明，在绝经后妇女中，SERM 可一致降低 35%或更多的 ER 阳性浸润性和非浸润性乳腺癌风险。美国的专业组织现在建议使用 SERM 来降低高危绝经后妇女的乳腺癌风险。雷洛昔芬和他莫昔芬在降低 ER 阳性浸润性乳腺癌风险方面具有同等疗效，但雷洛昔芬与他莫昔芬相比，在绝经后妇女中血栓栓塞疾病、良性子宫疾病和白内障的风险较低。没有证据表明，任何一种药物降低乳腺癌风险会转化为降低乳腺癌死亡率。雷洛昔芬或他莫昔芬的总体生活质量相似，但雷洛昔芬的性交困难、体重增加和肌肉骨骼投诉发生率较高，而他莫昔芬的血管舒缩症状、膀胱失禁、妇科症状和腿部痉挛发生率较高。
